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What Public Health Is

History and Philosophy of Public Health 2011

Scott Frank

on 4 September 2012

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Transcript of What Public Health Is

What Public Health Is Scott Frank, MD, MS
Director, Master of Public Health Program Public Health Medicine Population Health Objectives
Understand the distinction between public health, population health, and medicine
Review different ways in which public health is defined
Consider the historical and present tensions between the fields of medicine and public health
Discuss contribution of diverse professional fields to public health
List reasons impelling a change to a population health approach
Recognize opportunities to improve health and medical care through population health sciences Improving the health of populations through community intervention “public health thinkers see into the future, for they
understand that it is the first cigarette that kills and
not the last” (Foege, 2000). Public Health is the art of using science to expand the possible
-Michael Resnick Ten Greatest Public Health Achievements of the Past Century
Motor Vehicle Safety
Workplace Safety
Control of Infectious Disease
Declines in Deaths from Heart Disease and Stroke
Safer and Healthier Foods
Healthier Mothers and Babies
Family Planning
Fluoridation of Drinking Water
Tobacco as a Health Hazard Defined by what we must know:
Public Health Practice
Health Behavior
Health Policy
Environmental Health And by how what we must know changes:
Health Communication
Cultural Competence
Quality Improvement
Community Participatory Research
Genetic Epidemiology
Health Informatics
Global Health
Health Services Research
Genomics Diagnosing, treating, or preventing disease in individuals through medical intervention Medicine
Disease Model
Preventive Medicine
Beneficence as individual good
Interpersonal communication
Incentives for care of the insured Public Health
Wellness Model
Health Promotion
Beneficence as public good
Social Marketing and Health Communication
Incentives for universal health care Population Health involves defining and measuring the health of populations, with focus on factors that determine health and the policies and programs that influence those determinants Population health can be viewed as a “guiding synthesis” for public health and medicine
Differs from Public Health
“major determinants such as medical care, education, and income remain outside of public health authority and responsibility”
“current resources do not even allow adequate attention to traditional and emerging public health functions”
Differs from Medicine
Attention to populations
Emphasis on health policy
Focus on broad definition of health rather than disease Why Population Health Is
The call to population health is a consequence of the failures of public health and medicine
Medical error
Health inequities
Cost of and access to healthcare
Difficulty managing the explosion of medical knowledge and technologies
Limitations of the biomedical model
Limited effectiveness of large-scale preventive programs
Impatience of the public and young professionals with the irrational self serving battles generated in a world no longer relevant to present solutions Population Health determinants include:
Medical care
Public health interventions
The social environment
The physical environment
Individual behavior
Individual biology 1) Everybody = Anyone 2) Life, Liberty and
the Pursuit of Healthiness 3) Be Bold Principles for Authentic Public Health 4) Mind the Public 5) It’s Not about You, it’s Not about Them,
it’s about Us 6) Policy ≥ Program 7) Do Best What People Need Most 8) Relationship 9) Relationship 10) Relationship Of 13 countries in a recent comparison, the United States ranks an average of 12th (second from the bottom) for 16 available health indicators
13th (last) for low-birth-weight percentages
13th for neonatal mortality and infant mortality overall
11th for postneonatal mortality
13th for years of potential life lost (excluding external causes)
11th for life expectancy at 1 year for females, 12th for males
10th for life expectancy at 15 years for females, 12th for males
10th for life expectancy at 40 years for females, 9th for males
7th for life expectancy at 65 years for females, 7th for males
3rd for life expectancy at 80 years for females, 3rd for males
10th for age-adjusted mortality

Starfield, JAMA. 2000;284:483-485 Is US Health Really the Best in the World? Winnable Battles (CDC 2010) Defined by our history Defined by Our Values Four Public Health Archetypes Robin Hood Don Quixote Machiavelli Steven Jobs Defined by what we must do Essentials of Public Health Public Health Model
Environment 1. Institute a Rational Health Care System
2. Eliminate Health Disparities
3. Focus on Children’s Emotional and Intellectual Development
4. Achieve a Longer “Healthspan”
5. Integrate Physical Activity and Healthy Eating into Daily Lives
6. Clean Up and Protect the Environment
7. Prepare to Respond to Emerging Infectious Disease
8. Recognize and Address the Contributions of Mental Health to Overall Health and Well-being
9. Reduce the Toll of Violence on Society
10.Use New Scientific Knowledge and Technology Wisely Defined by our Priorities Underaged Drinking: What would you do? Definition of Health (WHO, 1946, 1948)

A state of complete physical, social, mental wellbeing, and not merely the absence of infirmity or disease

Health is a resource for everyday life, and not the object of living. It is a positive concept emphasizing social and personal resources as well as physical capability.

Health is a fundamental human right. Heal: verb
1. To make sound or whole.
2. To restore integrity and purity. Cure: verb
1. To remove disease.
2. To preserve meat by smoking, pickling or hanging out to dry. 10 Conventional Tips for Better Health

1. Don’t smoke. If you can, stop. If you can’t, cut down.

2. Stay on a balanced diet with plenty of fruits and vegetables.

3. Stay physically active. Exercise at least 3 times per week.

4. Manage stress: take time to slow down; take relaxing getaways.

5. If you drink, do so in moderation.

6. Cover up in the sun.

7. Make sure you practice safer sex

8. Get regular check-ups and get screenings for cancer.

9. Be safe on the roadways. Follow highway codes and wear your seatbelts.

10. Wash your hands. At least 5 times a day.

Adapted from Dave Gordon, University of Bristol, and Dennis Raphael, York University 10 Tips for Better Health Your Doctor Didn’t Tell You

1. Don’t be poor. If you can, stop. If you can’t, try not to be poor for long.

2. Live near good supermarkets and affordable fresh produce stores.

3. Live in safe neighborhoods with parks and green spaces nearby.

4. Work in a rewarding and respected job with good compensation, benefits and control over your work.

5. If you work, don’t lose your job or get laid off.

6. Take family vacations and all the benefits you are entitled to.

7. Make sure you have wealthy parents.

8. Don’t live in damp, low quality housing, next to a busy road or near a polluting factory.

9. Be sure to own a car if you have to rely on neglected public transportation.

10. Learn how to fill in the complex housing benefit application forms before you become homeless and destitute.

Adapted from Dave Gordon, University of Bristol, and Dennis Raphael, York University Public Health in Popular Culture (Dr. Frank's) Top Public Health Songs Top Public Health Movies Top Public Health Television Top Public Health Books
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